Use of face masks by the general public

Version 1.1

Introduction
This guide was written to give people information about the use of face coverings in everyday life. The guidance is not for healthcare settings. There is guidance for the healthcare setting on the HPSC website.

Information about the disease
COVID-19 is the name given by the World Health Organization (WHO) to the infectious disease that was first noticed in China late last year. The disease is caused by a virus that spreads from person to person. The proper name of the virus is SARS-CoV-2 (pronounced sars-co-v-two). A virus is a type of microorganism or a bug. A virus is too small to see, even smaller than bacteria. A virus grows inside a living person or animal. This virus seems to have crossed over from an animal to people in late 2019 and has now spread very widely among people all over the world.

How is the virus spread
This virus is shed from the nose and mouth of people in droplets of water when they talk, cough, sneeze or laugh.

Droplets from the mouth and nose come in very wide range of sizes. Some droplets are so big you can see them. If someone has ever sneezed in your face you can feel the bigger droplets hit you. Many of the droplets are much too small to see but are still many times the size of a virus and may carry virus within the droplets.

The droplets can land in the mouth or eyes of a person standing nearby. The risk of virus spread as a result of droplets landing directly in the eyes, nose or mouth is much lower if people keep a safe distance between each other. If there is more than 2 metres distance between people the chance of spread by droplets landing directly in the eyes, nose or mouth is very low.

Droplets carrying virus also land on surfaces like table tops, door handles and many other things that you touch. When you touch these things, the virus can get on your hands. Droplets will land directly on your hand if you cover your mouth and nose with your hand when you cough or sneeze. This is why we now advise that you use a tissue and bin it, and if you don’t have a tissue use the crook of your elbow not your hand. If you have the virus and you cough or sneeze the droplets onto your hands you will put the virus onto everything you touch including other people you shake hands with or touch. The virus cannot infect people through the skin but if virus is on their hand and they put their hand to their eyes nose or mouth the virus can attach to the mucous membrane and start infection. A gloved hand can carry the virus to your eyes, nose and mouth just as easily as a bare hand.

When the virus gets into a new person it starts to multiply quite quickly. People usually do not become sick for about five days after they catch the virus. Some people do not get sick for up to 14 days. The most common symptoms are fever, cough and shortness of breath but there are many other less common symptoms. Some people get no symptoms or have such mild symptoms that they hardly notice it.

People are generally most likely to spread the virus to others about the time they develop symptoms and, in the days, after they develop symptoms. People with COVID-19 are advised that the can be a risk to other people for 14 days from the day when they become sick. They are advised to avoid contact with other people during those 14 days.

The virus can spread from people before they get sick. It can also spread from people who never get symptoms or have such mild symptoms that they hardly notice it. It is not possible to be sure how important spread from people without symptoms. Some experts believe spread from people with no symptoms or very mild symptoms plays a big part in the spread of the virus. Other experts think it plays only a small part in the spread of the virus.

The potential for spread of COVID-19 in schools and similar settings where children and young people congregate merits specific consideration. There is one study that reports very low rates of infection and low spread of COVID-19 in schools. However, this does not appear to apply to older children/young people in the age 15 to 17 as another study shows that they are equally likely to acquire infection in school as adults in a school setting. Overall the evidence is that children seem less likely than adults to acquire infection. There is no evidence that children are more likely than adults to infect others. In fact, at present the evidence indicates that children are rarely the source of introduction of COVID-19 infection into a household.

Stopping the spread of the disease
Identifying people with symptoms of infection and making sure they stay away from other people (self isolation) while they are infectious is a very important part of stopping spread of the virus. This is why people with symptoms are asked to self isolate for 14 days.

Identifying people who have been in contact with a person with COVID-19 (contact tracing) and asking them to self isolate for 14 days from the time of contact is an important part of stopping spread of the virus.

Everyone, including people with no symptoms of COVID-19 should maintain a distance of 2 m from other people outside of their household whenever possible.

Hand hygiene is very important in stopping spread of COVID-19. If virus gets on the skin of your hands it does not cause infection if you wash it off your hands before you touch your eyes, nose or mouth. Wearing gloves is not recommended for preventing spread of COVID-19 except in certain healthcare settings.

Healthcare workers in Ireland are recommended to wear a mask at work when caring for people and when they are going to be within 2 m of a colleague for more than 15 minutes. There is evidence that wearing a mask reduces the amount of droplets scattered from the nose and mouth. Although there is no definite proof of benefit, many experts and many expert groups believe that if everyone wears masks when they are within 2 m of other people this can reduce the risk that an infected person wearing a mask will spread the infection to other people. For this reason, some experts recommended that people wear a mask to protect other people when the wearer is in an enclosed indoor place where it is not possible to maintain a distance of 2m from other people. There is no value in wearing a mask if you are alone in a room or in your car or if you are outside and there is no one close to you. There is no value in wearing a mask when only in the company of someone with whom you sleep in the same bed or kiss on the lips.

Different types of face masks
There are broadly three types of masks: respirator masks, surgical masks (also called medical masks) and cloth masks.

Respirator facemasks are intended to filter out essentially all small particles from the air breathed by the wearer. The terms N95, FFP3, FFP2 and KN95 are some specifications that indicate a mask is a respirator mask. Respirator masks are recommended for use by healthcare workers in very specific situations to protect them from COVID-19 infection. In most healthcare situations they are not needed. Respirator masks are often expensive. They are only reliable if carefully fitted. Respirator masks are intended for use one time and for discard after use.

Surgical masks are the main type of mask used in healthcare settings to protect healthcare workers caring for a person with COVID-19. People with COVID-19 infection are also asked to wear a mask to reduce the amount of COVID-19 droplets that they scatter. There is some evidence that if everyone uses surgical masks in public places that this may reduce spread of virus similar to the virus that causes COVID-19. Surgical masks are intended for use one-time or single use and for discard after this one-time use.

Non-medical face coverings can be purchased or can be home made. They can be made from many different types of materials and in different designs. Cloth face coverings can be laundered and re-used.

Designs for cloth face coverings are available at the links below.
•    https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

•    https://www.gov.uk/government/publications/how-to-wear-and-make-a-cloth-face-covering/how-to-wear-and-make-a-cloth-face-covering
 
Choice of type of masks for use in the community
Medical masks are not recommended for use by the public. Their use in the community may make it more difficult to ensure that they are available to healthcare workers in those particular situations where they are necessary.

There is no rationale for use of a face covering of any kind in situations where the wearer can maintain a distance of 2 m from other people. People who use disposable face coverings will require a sufficient supply of them to avoid re-use. Those who choose to use cloth face coverings will require a number of them and each one should be laundered before re-use. It is important that the face coverings are stored safely before use and disposed of properly in the case of disposable face coverings or in the case of cloth face coverings, stored safely and laundered regularly to ensure that they are clean.

It is important also for members of the public who use face coverings to know that their use is not appropriate for some people. Children under 13 years of age are advised against wearing a face covering. Face coverings may make it very difficult to communicate with some people. Some people may find that wearing a face covering causes problems with skin, with their airway or cause anxiety or discomfort that they cannot tolerate. Prolonged use of face coverings can be associated with discomfort and with damage to the skin of the face. Limiting use of face coverings to those situations where the person is in an indoor space where a distance of 2m cannot be maintained will help to reduce the risk of discomfort and skin irritation.
 
If you choose to use a cloth face covering:

Do

• Do remember that proper hand hygiene is essential and remains a priority.
• Check that the face covering is made from a fabric that you are comfortable wearing.
• Check that the face covering is suitable for laundering at a temperature of at least 60 degrees celsius.
• Check that the face coverings are easy to fit and completely cover your nose and mouth.
• Carry the unused face covering in a sealable clean waterproof bag (for example a zip lock bag).
• Carry a second readily distinguishable sealable clean waterproof bag for storage of used face coverings.
• Practice fitting and removing the face covering so that you are comfortable applying and removing it readily.
• When you are about to enter a situation where face covering use is recommended put on a clean one and ensure it is covering your nose and mouth.
• Once the face covering is in place, try not to touch the front of it.
• Leave the face covering in place until you have left the situation where its use is needed or the face covering is damaged or wet.
• If your face covering is wet or soiled remove it and replace with a fresh one.
• When you remove the face covering do so without touching the front of it and place it in the bag for used face coverings.
• Clean your hands as soon as possible after removal of a face covering.
• Launder used face coverings on the evening of use at a temperature of at least 60 degrees Celsius.
• Check face coverings regularly for wear and damage and dispose of face coverings that are damaged.
• Dispose of face covering that are no longer required.
• Be aware that face covering use is not practical for everyone and that children under 13 year should not wear a face covering.
• Be aware that face coverings can pose a strangulation hazard and, in that context, may not be appropriate for use in certain settings

If you choose to use a cloth face covering:

Don’t

• Do not wear a face covering if under 13 years of age (unless specifically advised to do so by a healthcare provider).
• Do not wear a face covering if you have special needs or a disability that means that use of a face covering creates specific risks.
• Do not use face coverings instead of self-isolation.
• Do not use face coverings instead of keeping your distance of 2 m from other people whenever possible.
• Do not use face coverings instead of hand hygiene.
• Do not wear a face covering when you are alone in a room or in your car or in an open space away from other people.
• Do not allow other people to use a face covering that you have used (until laundered).
• Do not lower the face covering to speak, eat, and smoke or vape. If you need to uncover your nose or mouth remove the face covering and place in the bag for use face coverings.
• Do not place used face coverings on surfaces that are likely to be touched by other people in public places (for example on tables).
• Do not discard face coverings in public places other than into refuse bins.
• Do not criticise or judge people who are not able to wear a face covering.

Last updated: 15 May 2020